Healthcare Provider Details

I. General information

NPI: 1891900486
Provider Name (Legal Business Name): MOSES FALLAH APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CONNECTICUT DR SUITE 5
BURLINGTON NJ
08016-4177
US

IV. Provider business mailing address

14 BEAVERDALE LN
WILLINGBORO NJ
08046-1612
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6066
  • Fax:
Mailing address:
  • Phone: 609-481-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR11629300-
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00768800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: